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re: Interesting Article About SSRI's. HHS Director Kennedy vs Congress
Posted on 5/21/26 at 11:05 am to DeBoar
Posted on 5/21/26 at 11:05 am to DeBoar
I get that kind of response from people a lot. Therapy is a situation that requires a lot of trust and it really helps to have someone you can identify with. It sounds like your community could use more therapists like that.
1
Posted on 5/21/26 at 11:07 am to TigerDoc
lol Jesus. Yeah let’s have a lesbian relate to little children. The only thing they have in common is a small mind. Same therapists and counselors who buy into the feelings of trans because it’s okay to be different. GTFO
Posted on 5/21/26 at 11:08 am to TigerDoc
quote:
I just don't buy into the idea that if experts don’t possess complete mechanistic understanding, then the product is illegitimate/corrupt. We saved a gazillion soldiers' lives with penicillin before we had a clue about how it was killing bacteria. It would've been better to have had the explanation, but it was defensible to give the treatment because research showed that it worked even though they didn't know how.
What a horrible analogy. You are comparing something you give one time that has a definitive result of working or not working, vs something people are on for life that has no definitive result of working, and may actually cause horrific problems.
This post was edited on 5/21/26 at 11:12 am
Posted on 5/21/26 at 11:08 am to Bjorn Cyborg
He’s losing his arguments real fast with what his last few responses are. And what you mentioned hasn’t been discussed it’s being on them for life or the problems coming off them.
This post was edited on 5/21/26 at 11:09 am
Posted on 5/21/26 at 11:09 am to DeBoar
I actually agree with a lot of that. Having credentials in one area definitely doesn’t make somebody automatically wise or correct about everything else. Doctors, teachers, lawyers, professors, etc. are still just people with egos, blind spots, biases, personal issues, politics, all the normal human stuff.
Where expertise does matter IMO is narrower than people sometimes think. If I need heart surgery, I’d rather have somebody who’s done 5,000 of them than somebody who hasn’t. But that doesn’t mean the surgeon suddenly has deep insight into every social or political issue on earth.
Where expertise does matter IMO is narrower than people sometimes think. If I need heart surgery, I’d rather have somebody who’s done 5,000 of them than somebody who hasn’t. But that doesn’t mean the surgeon suddenly has deep insight into every social or political issue on earth.
Posted on 5/21/26 at 11:10 am to DeBoar
I think you misunderstood me there.
Posted on 5/21/26 at 11:11 am to TigerDoc
Perhaps I did. The other part though of how they say it’s okay to be different is disgusting.
Posted on 5/21/26 at 11:12 am to Bjorn Cyborg
That’s fair criticism of the analogy. Psychiatric meds are definitely messier than antibiotics because outcomes are more subjective/probabilistic,
treatment can be long term, side effects matter a lot, “working” isn’t always obvious or binary. I just don’t think “messy/complex/imperfect” automatically gets us all the way to “therefore these medications never meaningfully help anyone." I see them help people frequently, actually.
treatment can be long term, side effects matter a lot, “working” isn’t always obvious or binary. I just don’t think “messy/complex/imperfect” automatically gets us all the way to “therefore these medications never meaningfully help anyone." I see them help people frequently, actually.
Posted on 5/21/26 at 11:18 am to TigerDoc
I think education and certification is the problem these days with the medical field. Most hospitals and clinics are full of trash people. It’s weird that nurses who work for doctors can have tattoos piercings and look like a bag of arse while any other career doesn’t put up with that. Just like after college I applied for a corporate position at Pepsi and I didn’t accept the job offer because I couldn’t have a beard. So many people in healthcare are complete trash the last decade who get pushed through and it’s all subsidized.
Posted on 5/21/26 at 11:29 am to TigerDoc
quote:
Your orthopedist or pain management specialist doesn't do your PT, though you can benefit from services from each.
Your orthopedist or pain management specialist doesn't know anything about PT, though. Not unless they've gone out of their way to educate themselves outside of their normal training.
That's what I used to do for a living. I owned clinics that employed MDs, DCs, rehab teams, mid-levels, etc. and that's the type of work we did, so I know what I'm talking about. The MDs knew nothing about physical medicine/rehab whatsoever.
The exception would be a physiatrist, but they don't come around very often.
Anyway, psychiatrists are supposed to know how to do counseling/therapy.
quote:
It wouldn't be efficient to have MD's do all that therapy.
You mean it wouldn't be lucrative enough for them. They can bill a lot more 99214s in a day (which should be 99212s, if we're honest) when they see a patient every 15 minutes (maybe) than they can if they can only bill 9-10 90838s a day. 10 x $150 = $1500, but 40 x $135 = $5,400.
My problem with psychiatrists basically functioning as nothing more than psychotropic drug dealers is that those medications—while potentially useful—are also very risky. They ought to at least be doing therapy with them until a patient is stable on any given medication just so that they can monitor their responses to the meds IMO.
And yeah, insurance ought to make it more economically feasible for them to do so.
Posted on 5/21/26 at 11:34 am to wackatimesthree
Very fair. Psychotherapy is typically a 50 minute session and a psychiatrist would be able to see 8 or 9 patients a day. We'd have to train a whole lot more. I'd be good with that from a care perspective, though who knows how worthwhile it would be from a value perspective in the aggregate. LPC's and MSW's are way cheaper.
Posted on 5/21/26 at 11:37 am to SaintsTiger
quote:
There was a Time cover story on SSRIs a while back. Summarized all the science showing SSRIs do not work but have guaranteed horrible side effects.
I wonder if there is data that shows the increased use of SSRI/psychotropic drugs by children and adults coincide with the increase in suicide and mass shooting? I wonder?
Posted on 5/21/26 at 11:47 am to TigerDoc
quote:
We'd have to train a whole lot more
You're supposed to need therapy to get you through things in different stages of your life, not stay in therapy in perpetuity.
Posted on 5/21/26 at 11:50 am to LemmyLives
I agree. But if we had more well-trained people providing therapy there would probably be more of a demand for it.
Posted on 5/21/26 at 12:07 pm to wackatimesthree
quote:Correct.
Yeah, but that's not what he said.
It is exactly what he insinuated though.
Hence my response ....
quote:
That is a misleading innuendo.
The same could have been said of Penicillin, Aspirin, etc., when they were found effective.
Posted on 5/21/26 at 12:21 pm to TigerDoc
quote:
Then they slap a lynching for psych image at the top and instantly make the whole thing look like unc Facebook groups.
Tha frick is wrong with you Doc? That wasn't a "lynching" issue. That is suggesting that they give these depressed folks drugs that do not work (or certainly do not work as intended or through the pathway the makers say) and some of them end up committing suicide.
Now, whether or not some of those depressed folks would have taken those final, irreversible steps without SSRIs is up for debate, but no one wants to lynch psychiatrists (except Scientologists, of course.)
Posted on 5/21/26 at 12:23 pm to Bass Tiger
quote:
I wonder if there is data that shows the increased use of SSRI/psychotropic drugs by children and adults coincide with the increase in suicide and mass shooting? I wonder?
Unfortunately there are no studies. Wonder why ….
Posted on 5/21/26 at 12:34 pm to lake chuck fan
The latest "gold standard" meta-analysis on this question was done in 2018.
Conclusion:
Bottom line:
1) SSRIs are not worth it in people with mild depression (they don't work well). There is a larger benefit in moderate to severe depression.
2) About 50-60% of people respond (which means 40% of people get no benefit at all). Out of those that do respond, most of them respond modestly. A minority will have a strong response.
3) The response isn't as strong as they thought in the 80's, but it still beats placebo. And every drug tested beats placebo (some more than others).
quote:
We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89-2·41) for amitriptyline and 1·37 (1·16-1·63) for reboxetine. For acceptability, only agomelatine (OR 0·84, 95% CrI 0·72-0·97) and fluoxetine (0·88, 0·80-0·96) were associated with fewer dropouts than placebo, whereas clomipramine was worse than placebo (1·30, 1·01-1·68). When all trials were considered, differences in ORs between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability, with wide CrIs on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19-1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51-0·84).
Conclusion:
quote:
All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials.
Bottom line:
1) SSRIs are not worth it in people with mild depression (they don't work well). There is a larger benefit in moderate to severe depression.
2) About 50-60% of people respond (which means 40% of people get no benefit at all). Out of those that do respond, most of them respond modestly. A minority will have a strong response.
3) The response isn't as strong as they thought in the 80's, but it still beats placebo. And every drug tested beats placebo (some more than others).
Posted on 5/21/26 at 1:04 pm to wackatimesthree
quote:No offense, but either you are badly underestimating their knowledge (very common), or you were working with relative idiots. That said, why in the world would a PM&R clinic employing MDs, not employ PM&R MDs?
The MDs knew nothing about physical medicine/rehab whatsoever.
quote:I'd guess you've never shadowed a Psychiatrist for even one day? TD is right though, aside from something like amytal or lorazepam interviews, Psych is too poorly reimbursed to introduce the additional inefficiencies of couch chats.
My problem with psychiatrists basically functioning as nothing more than psychotropic drug dealers is that those medications—while potentially useful—are also very risky.
Posted on 5/21/26 at 1:46 pm to NC_Tigah
quote:
No offense, but either you are badly underestimating their knowledge (very common), or you were working with relative idiots.
Well, let's see who has the basis to comment here. I've employed multiple doctors—not orthopedists, but pain management specialists. One of them was double board certified in both neurology and pain management, so I don't think he was an idiot.
Let's start with this question:
What's your speciality?
quote:
That said, why in the world would a PM&R clinic employing MDs, not employ PM&R MDs?
First of all, we weren't practicing pain management as such. No opioids, very few pharmaceuticals prescribed at all. The MDs were there to do joint and trigger point injections (never steroids, sometimes HA, but more often PRP) and they were the medical directors.
Why didn't we have a physiatrist? We tried, but the are few and far between and are in such high demand that we couldn't get them. They had their pick of locations. Where I was located in Alabama wasn't sexy enough for any of them.
Also, people don't realize this, but the medical lobby in Alabama is very strong and they keep salaries for physicians very high. Mostly by severely limiting what mid-levels are able to do. I don't know if it's still this way, but at one point during my tenure Alabama had the second highest average physician salary in the country behind only California. So we probably couldn't have afforded any of the physiatrists even if they had agreed to come to Alabama.
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